Diagnosis and management of primary hyperparathyroidism

Department of Medicine, McMaster University, Hamilton, ON, Canada.
BMJ (online) (Impact Factor: 17.45). 03/2012; 344(7849):e1013. DOI: 10.1136/bmj.e1013
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Available from: Aliya Khan, Mar 29, 2014
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    • "Only four cases have been reported in the sphenoid bone, two cases due to primary hyperparathyroidism and two cases due to secondary hyperparathyroidism [11] [12] [13] [14]. The association of brown tumors and parathyroid carcinoma has been seldom reported due to the fact that brown tumors are formed slowly, late in the natural history of primary hyperparathyroidism [1] [2] [3] [4]. In this sense, the rapid growth and progression of a parathyroid carcinoma rarely provide the enough time for a brown tumor to develop. "
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    ABSTRACT: Brown tumors are osteolytic bone lesions that occur as a result of persistent hyperparathyroidism. They usually appear late in the natural history of the disease and are currently very rare due to an earlier diagnosis of primary hyperparathyroidism. We present the case of a 53-year-old female with a 2-month history of bitemporal hemianopsia and diplopia. A computed tomography showed an osteolytic bone lesion that involved the sphenoid corpus and clivus. A biopsy was made and the histopathology result was consistent with a brown tumor. The aforementioned location is very infrequent to such tumors, and therefore represented a diagnostic challenge. However, in this case, its association to primary hyperparathyroidism was the clue for the diagnosis. The association of a brown tumor secondary to a parathyroid carcinoma has been seldom reported. This case represents, to our knowledge, one of the few brown tumors described in such location and the first secondary to a parathyroid carcinoma.
    Case Reports in Endocrinology 09/2014; 2014:837204. DOI:10.1155/2014/837204
    • "Limited data is available on the surgical approach to PHPT in most of the literature from India. The approach has ranged from bilateral conventional neck exploration and unilateral neck exploration to focused parathyroidectomy.[416] Although surgery is the definitive cure, not all patients undergo undergo parathyroidectomy. "
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    ABSTRACT: Primary hyperparathyroidism is a common condition that affects 0.3% of the general population in which excessive production of PTH is there. With changing trends it is diagnosed early and asymptomatically with the improvements in routine biochemical tests and radiological procedures. The late bony complications of the disease have therefore started to decline rapidly. The mandible is the predominantly affected site in the maxillofacial area. Maxillary involvement is rare. Here, we reported series of three cases of 30-40-year-old women with osteolytic lesions and bone resorption in maxilla or mandible. Two of presented cases demonstrated evidence of lesions in both mandible and maxilla which is a very rare event. A thorough diagnostic work-up emphasizing on biochemical and radiographic investigations were discussed. We highlighted the role of endocrinologist, oral and maxillofacial surgeons, general practitioner dentists, and radiologists in diagnosing and managing such patients.
    Journal of laboratory physicians 07/2013; 5(2):113-7. DOI:10.4103/0974-2727.119863
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    ABSTRACT: To investigate the prevalence of cardiovascular risk factors in patients with primary hyperparathyroidism (PHPT) and to determine if they are gender specific. This was a retrospective case control study. Three hundred and sixty-three men and women with PHPT and 363 age-, sex-, and body mass index (BMI)-matched controls with benign goiter were included in the study. We documented each patient's laboratory results along with the presence of any cardiovascular risk factors. Intra-operatively, the resected parathyroid adenomas were weighed and recorded. The data are expressed as the number of patients in each category and percentage of total patients in that group and the mean±SD. The prevalence of obesity, hypertension, hyperlipidemia, Type 2 diabetes, and coronary artery disease (CAD) is higher in PHPT patients compared to the general New Jersey population and age-, sex-, and BMI-matched goiter patients. Male PHPT patients tended to be more obese and were found to have heavier parathyroid adenomas compared to female patients (p<0.05). Additionally, a higher percentage of male PHPT patients were found to have higher rates of CAD (11.5%) and Type 2 diabetes (23.0%) compared to female patients (5.80% and 10.9%, respectively, p<0.05). There is a higher prevalence of metabolic disorders and CAD in PHPT patients. Male PHPT patients had larger parathyroid adenomas at the time of surgery and had a higher prevalence of obesity, Type 2 diabetes and CAD compared to female PHPT patients.
    Journal of endocrinological investigation 07/2011; 35(6):548-52. DOI:10.3275/7861 · 1.45 Impact Factor
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